|
|
Perceptual Learning for Improvement of Visual Function in AmblyopicChildren: A Prospective Study |
Xiaofang Ren,Lin Xiao,Shaoming Yan,Mingdi Yang,Deyi Zhuo |
Department of Ophthalmology, Beijing Shijitan Hospital Affiliated with Capital University of Medical Science, Beijing 100038, China;
Department of Ophthalmology, General Hospital of the Navy, Beijing 100037, China. |
|
|
Abstract Objective: To evaluate the efficacy of the multimedia visual perceptual learning system for improving visual acuity in pediatric patients with amblyopia and to discuss factors influencing the therapeutic effects of perceptual learning. Methods: This was a prospective randomized controlled study. Amblyopic children aged from 3 to 11 years (n=112) were recruited from the ophthalmology clinic. Participants were randomly assigned to the experimental group that utilized the multimedia visual perceptual learning system or a control group utilizing the synoptophore. All subjects underwent perceptual learning and patching or refractive correction, depending upon the individual situation. After the baseline visit, follow-up visits were held after 10, 20, and 30 treatments. Finally, the clinical efficacy and improvement of visual acuity in the two groups were analyzed and compared, using chi-square test, independent-samples t test, Pearson correlation test. Results: The curative effect of the experimental group was better than the control group at different training periods (Z=-4.128, -4.806, -3.063, P<0.001). The change in visual acuity in the experimental group was significantly higher at the 10th and 20th training sessions (t=3.471, 3.290, P<0.05).In the moderate and severe amblyopia groups, the curative effect of the experimental group was better than the control group (Z=-3.050, P=0.021), and was the same as in the anisometropic amblyopia group
(Z=-2.864, P=0.004) and 7-11 year-old group (Z=-2.631, P=0.009). There was a moderate correlation at baseline and an improvement in visual acuity in both groups (r=0.690, 0.650, P<0.05). Conclusions: The multimedia visual perceptual learning system can achieve an optimal effect in a short period of time. The improvement in vision relates to the sex of the patient, and the degree and type of amblyopia, which are clinically significant to amblyopia therapy.
|
Received: 13 November 2016
|
Fund: This study was funded by Beijing Capital Medical Development Foundation (2011-2008-08) |
Corresponding Authors:
Lin Xiao, Department of Ophthalmology, Beijing Shijitan Hospital Affiliated with Capital University of Medical Science, Beijing 100038, China (Email: xiaolin1957@126.com)
|
|
|
|
[1] |
Zhang JY, Zhang GL, Xiao LQ, et al. Rule-based learning explains visual perceptual learning and its specificity and transfer. J Neurosci, 2010, 30(37): 12323-12328. DOI: 10.1523/
|
|
JNEUROSCI.0704-10.2010.
|
[2] |
Wong AM. New concepts concerning the neural mechanisms of amblyopia and their clinical implications. Can J Ophthalmol,2012, 47(5): 399-409. DOI: 10.1016/j.jcjo.2012.05.002.
|
[3] |
Birch EE. Amblyopia and binocular vision. Prog Retin Eye Res,2013, 33: 67-84. DOI: 10.1016/j.preteyeres.2012.11.001.
|
[4] |
Gunton KB. Advances in amblyopia: what have we learned from PEDIG trials?. Pediatrics, 2013, 131(3): 540-547. DOI: 10.1542/peds.2012-1622.
|
[5] |
Levi DM. Prentice award lecture 2011: removing the brakes on plasticity in the amblyopic brain. Optom Vis Sci, 2012, 89(6):827-838. DOI: 10.1097/OPX.0b013e318257a187.
|
[6] |
Tsodyks M, GiIbert C. Neural inetworks and perceptual learning. Nature, 2004, 431(7010): 775-781.
|
[7] |
Li RW, Young KG, Hoenig P, et al. Perceptual learning improves visual performance in juvenile amblyopia. Invest Ophthalmol Vis Sci, 2005, 46(9): 3161-3168. DOI: 10.1167/iovs.05-0286.
|
[8] |
中华医学会眼科学分会斜视与小儿眼科学组. 弱视诊断专家共识(2011年). 中华眼科杂志, 2011, 47(8): 768. DOI: 10.3760/cma.j.issn.0412-4081.2011.08.027.
|
[9] |
Gunton KB. Advances in amblyopia: what have we learned from PEDIG trials?. Pediatrics, 2013, 131(3): 540-547. DOI: 10.1542/
|
|
peds.2012-1622.
|
[10] |
Chen PL, Chen JT, Fu JJ, et al. A pilot study of anisometropic amblyopia improved in adults and children by perceptual learning: an alternative treatment to patching. Ophthalmic Physiol Opt, 2008, 28(5): 422-428. DOI: 10.1111/j.1475-1313.2008.
|
00 |
588.x.
|
[11] |
Zhou Y, Huang C, Xu P, et al. Perceptual learning improves contrast sensitivity and visual acuity in adults with anisometropic amblyopia. Vision Res, 2006, 46(5): 739-750. DOI: 10.
|
10 |
16/j.visres.2005.07.031.
|
[12] |
Hussain Z, Astle AT, Webb BS, et al. The challenges of developing a contrast-based video game for treatment of amblyopia. Front Psychol, 2014, 5: 1210. DOI: 10.3389/fpsyg.
|
20 |
14.01210.
|
[13] |
Li RW, Ngo C, Nguyen J, et al. Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol, 2011, 9(8): e1001135. DOI: 10.1371/journal.pbio.
|
10 |
01135.
|
[14] |
To L, Thompson B, Blum JR, et al. A game platform for treatment of amblyopia. IEEE Trans Neural Syst Rehabil Eng,2011, 19(3): 280-289. DOI: 10.1109/TNSRE.2011.2115255.
|
[15] |
Hess RF, Thompson B, Black JM, et al. An iPod treatment of amblyopia: an updated binocular approach. Optometry, 2012, 83(2): 87-94.
|
[16] |
Jeon ST, Maurer D, Lewis TL. The effect of video game training on the vision of adults with bilateral deprivation amblyopia. Seeing Perceiving, 2012, 25(5): 493-520.
|
[17] |
Knox PJ, Simmers AJ, Gray LS, et al. An exploratory study:prolonged periods of binocular stimulation can provide an effective treatment for childhood amblyopia. Invest Ophthalmol
|
|
Vis Sci, 2012, 53(2): 817-824. DOI: 10.1167/iovs.11-8219.
|
[18] |
Herbison N, Cobb S, Gregson R, et al. Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study of 3D shutter glasses system. Eye (Lond), 2013, 27(9): 1077-1083. DOI:10.1038/eye.2013.113.
|
[19] |
Hussain Z, Astle AT, Webb BS, et al. The challenges of developing a contrast-based video game for treatment of amblyopia. Front Psychol, 2014, 5: 1210. DOI: 10.3389/fpsyg.
|
20 |
14.01210.
|
[20] |
Baker DH, Meese TS, Hess RF. Contrast masking in strabismic amblyopia: attenuation, noise, interocular suppression and binocular summation. Vision Res, 2008, 48(15): 1625-1640.DOI: 10.1016/j.visres.2008.04.017.
|
[21] |
Levi DM, Li RW. Perceptual learning as a potential treatment for amblyopia: a mini-review. Vision Res, 2009, 49(21): 2535-2549. DOI: 10.1016/j.visres.2009.02.010.
|
[22] |
Li RW, Klein SA, Levi DM. Prolonged perceptual learning of positional acuity in adult amblyopia: perceptual template retuning dynamics. J Neurosci, 2008, 28(52): 14223-14229.
|
|
DOI: 10. 1523/JNEUROSCI.4271-08.2008.
|
[23] |
Chen PL, Chen JT, Fu JJ, et al. A pilot study of anisometropic amblyopia improved in adults and children by perceptual learning: an alternative treatment to patching. Ophthalmic
|
|
Physiol Opt, 2008, 28(5): 422-428. DOI: 10.1111/j.1475-1313.2008. 00588.x.
|
[24] |
Polat U, Ma-Naim T, Belkin M, et al. Improving vision in adult amblyopia by perceptual learning. Proc Natl Acad Sci U S A,2004, 101(17): 6692-6697. DOI:10.1073/pnas.0401200101.
|
[25] |
Levi DM, Knill DC, Bavelier D. Stereopsis and amblyopia:A mini-review. Vision Res, 2015, 114: 17-30. DOI: 10.1016/j.visres.2015.01.002.
|
|
|
|